HKCR Medical Questionnaire
Please answer as fully as possible. You are expected to include anything you think may be important. If you do not disclose medical information to the HKCR, this could invalidate your contract.
Please allow 10-15 minutes to complete this form, and have your personal information to hand. If you have any medical issues found on your medical questionnaire, you will be contacted to have further investigation when needed.
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Date completed *
MM
/
DD
/
YYYY
Player First Name *
Must be identical to your ID or passport
Player Last Name *
Must be identical to your ID or passport
Date of birth *
Day / Month / Year
MM
/
DD
/
YYYY
Gender *
Current HKCR Team/ Squad *
Club team
Playing Position(s) *
e.g. Front Row, Wing, Prop, Referee
Nationality *
Hong Kong ID *
Answer "N/A" if you do not have HKID
Passport number *
Answer "N/A" if you do not have passport
Player address *
Players Phone number *
Players Email address *
General Practitioner
Name of GP and Clinic location
Emergency Contact Name *
Emergency Contact Relationship *
Emergency Contact - best phone number *
Emergency Contact - Email Address *
Do you have medical insurance? *
Required
If  yes, name of insurance Company(e.g. BUPA), level of cover, and expiry date
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